Trends in screening for social risk in US physician practices
Open accessAbstract
Importance: A wealth of research on screening for social risks in health care has emerged, but evidence is lacking on how social risk screening among physician practices has changed over time. Objectives: To evaluate trends in screening for social risks among US physician practices and examine practice characteristics associated with adoption of social risk screening. Design, Setting, and Participants: The main analysis used a repeated cross-sectional design to analyze results from US physician practices that completed the National Survey of Healthcare Organizations and Systems, a nationally representative survey of physician practices, in 2017 and 2022. Sensitivity analysis tested robustness in a cohort of practices that completed surveys in both years. Exposures: Survey year and characteristics of physician practices. Main Outcomes and Measures: Whether physician practices systematically screened patients for 5 common social risks: food, housing, utilities, interpersonal violence, and transportation. Results: In this cross-sectional study, 3442 practice survey responses were studied. Weighted results showed that in 2022, 27% (95% CI, 23%-32%) of practices reported screening for all 5 of the social risks, an increase from 15% (95% CI, 13%-18%) of practices in 2017 (P < .001). Unadjusted results showed a significant increase in the mean number of social risks screened per practice, from 1.71 (95% CI, 1.60-1.82) in 2017 to 2.34 (95% CI, 2.12-2.55) in 2022. Practice characteristics associated with screening for more social risks remained consistent between 2017 and 2022; these included being a federally qualified health center (incidence rate ratio [IRR], 1.550 [95% CI, 1.336-1.799]) and having higher innovation culture scores (IRR, 1.012 [95% CI, 1.010-1.015]), higher advanced information system scores (IRR, 1.003 [95% CI, 1.001-1.005]), and higher payment reform exposure scores (IRR, 1.002 [95% CI, 1.000-1.003]). Conclusions and Relevance: In this survey-based cross-sectional study of US physician practices, social risk screening increased substantially from 2017 to 2022, although still less than one-third of practices systematically screened for a set of 5 common social risks. What remains to be seen is whether practices use these data to help improve patient health by adjusting health care or referring patients for assistance with social needs. As policies and incentives increasingly emphasize social risk screening, it will be important to assess the association of screening and referrals with patient outcomes.
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Individual-level SDoH data collection remains evolving and is not yet consistently available across large populations.
“individual-level SDoH data collection remains evolving and not yet consistently available across large populations [95–98]”
From Machine learning-driven risk prediction for post-hospitalization diabetes case management: Integrating clinical and social determinants of health (2026) · cites this paper as [96]
The Results report that systematic screening for all five social risks rose from 15% of physician practices in 2017 to 27% in 2022, supporting the claim that collection practices are evolving and uneven. But the Methods measure whether practices have screening systems, not whether individual-level SDoH data are consistently available across large populations; the Discussion’s Limitations also say the survey cannot show how screening is implemented. (LLM, conf=0.84)
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References 12 · Cited by 15
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- Authors
- Brewster, A. L., Rodriguez, H. P., Murray, G. F., Lewis, V. A., Schifferdecker, K. E., & Fisher, E. S.
- Affiliations
- University of California, Berkeley (US)
- Division of Health Policy and Management, School of Public Health, University of California, Berkeley, Berkeley
- New York University (US)
- University of North Carolina at Chapel Hill (US)
- Dartmouth Institute for Health Policy and Clinical Practice (US)
- Corresponding author
- Brewster, Amanda L.
- Venue
- JAMA Network Open
- Publisher
- American Medical Association (AMA)
- Published
- 2025-01-03
- Volume
- 8
- Issue
- 1
- Pages
- e2453117
- ISSN
- 2574-3805 (ISSN-L)
- PMC
- PMC11699528
- OpenAlex
- W4406048530
- Cited by
- 15
- References
- 12
- Citations by year
- 2026: 8 · 2025: 7
- FWCI
- 16.85
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- cc-by
- Locations
- JAMA Network Open (publishedVersion, cc-by)
- PubMed (publishedVersion)
- PubMed Central (publishedVersion, cc-by)
- Funders
- National Institute on Aging (R01AG084611)
- Topics
- Social Sciences › Health › Health disparities and outcomes
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Health Promotion and Cardiovascular Prevention
- Social Sciences › Health › Public Health and Social Inequalities
- Keywords
- social risk screening, social determinants of health, physician practice, food insecurity, housing insecurity, interpersonal violence, transportation insecurity, federally qualified health centers, innovation culture, health information systems, payment reform, healthcare quality improvement, health equity, health workforce shortage
- MeSH terms
- Cross-Sectional Studies, Female, Housing, Humans, Male, Mass Screening, Practice Patterns, Physicians', Surveys and Questionnaires, United States
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